At different points, the large pulmonary blood-vessels crossed the
cavity in the form of cords, with portions of structure attached, and
though these fragments had a black appearance, they exhibited, to a
considerable extent, their original cellular structure when washed in
water. The process of carbonaceous ulceration had proceeded so far in
this lung, that at some points the pleura pulmonalis, which was much
thickened, was left the sole medium between the contents of the sac and
the cavity of the chest; while in other parts it was thick and spongy.
On examining more minutely with the magnifier, open-mouthed bronchial
twigs, and very small blood-vessels, were seen plugged up with solid and
fluid carbon, and, from the appearance of the morbid structure, it was
manifest, that the ulcerative process had effected a complete
disorganization of the _bronchial_ tubes of every calibre, while the
smaller _arterial_ vessels had alone suffered, leaving the larger ones
entire.[11] Along the margin of the inferior lobe, indurated
accumulations were felt through the pleura, and, on being laid open,
they were ascertained to be impacted lobules, which resisted the knife.
Previous to the division, both lungs weighed about six pounds.
On examining the right lung, which seemed much similar in weight to the
left, and on making a section throughout its three lobes, the morbid
appearances varied in each. The upper lobe was infiltrated with carbon
into the interlobular cellular tissue, leaving the bronchial
ramifications respirable, and lubricated with frothy mucus. The middle
lobe presented a solid appearance, and contained a mass of indurated
black matter, of the size of a largish apple, and consistency of
consolidated blacking. The surrounding parenchymatous substance was
disorganized, and undergoing the process of softening. In dividing the
indurated substance, its internal structure exhibited a variety of
greyish lines, forming parallel and transverse ramifications, which
resembled small check in appearance, and which, when more accurately
examined, was ascertained to be the disorganised walls of the minute
air-cells and cellular tissue. The inferior lobe presented a state of
complete infiltration, with the air-cells generally entire, and on
putting a piece of it into water, it showed its density by sinking.
When we examine the morbid appearances in this case, and compare them
with the symptoms--when we consider that nearly all the respiration
carried on in this man's chest, was performed in the upper lobe of the
right lung, we are not surprised at his sufferings, nor is there much
difficulty in explaining the very painful dyspnoea, on his attempting
the recumbent position; and as death was instantaneous, it was evident
that the immediate cause was the bursting of the left pulmonary cyst
into the corresponding bronchus; the fluid carbon thus finding its way
to the trachea, produced suffocation.
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